My first job as a physician assistant was in a neuro-oncology department. I was young, newly certified, and eager to interact with patients. The physician who mentored me there made sure I had the opportunity to counsel patients, and provide guidance and comfort after a new diagnosis. These are situations where a clinician needs time and space to be empathetic.
On one occasion, I spent nearly 45 minutes in the exam room with a young woman who was just diagnosed with glioblastoma, a terminal illness. While we talked a bit about the diagnosis itself and what the coming months would entail, most of my time in that room was spent sitting with her and her husband as the reality of the news sank in.
I didn’t look for my moment to move on to the next patient. I didn’t let my thoughts drift to the many other tasks that awaited me outside of that room. I just stayed present, with my patient, in her time of need.
Time with patients, time to be empathetic, time to connect with the human life in front of you. Unfortunately, that time has become a luxury for clinicians, and few can afford it. It’s why I left the field.
Why I left medicine
My experience practicing medicine is not an uncommon one. I’d walk to work every day with a sense of dread, knowing I wouldn’t have time over the course of my 12-hour shift to accomplish everything I needed to. Before I even entered the hospital, the clock was working against me. As soon as I stepped into the building and logged into the EHR, I was met with a list of 15 patients experiencing acute issues. Each required my undivided attention.
I saw it as my duty to give every patient the attention and comfort they needed and deserved, but a cascade of other tasks competed for my time. The amount of administrative work put on clinicians is already considerable; as the clinician shortage exacerbates and demand for care grows, time with patients is shrinking. Inevitably, remaining empathetic in the face of these stressors becomes a challenge.
This is, unfortunately, the grim reality of the practice of medicine today. At the end of the day, there is no incentive for empathy. There are plenty of incentives for efficiency and throughput, but the only “reward” for providing empathetic care is extra time playing catch up at the end of the night. To do this job well requires attention and compassion. Those behaviors are at odds with the current model of care delivery, and technology has exacerbated the problem.
New tools were introduced every few months over the course of my career, all of which were supposed to make my job easier. These technologies promised to reduce clicks, to streamline workflows, and ultimately allow us to focus on our patients. All the non-clinical work was supposed to go away or get easier, and it never did.
So I hung up my stethoscope, hoping to use my clinical experience to make those technologies fulfill their promises before picking it up again. Recent advancements in AI have accelerated my timeline.
The promise of AI
A former colleague once challenged each of his med students to report one detail about a patient’s life outside of the hospital during their stay. It may seem trivial, but it was meant to reinforce the idea that patients are humans, with families and lived experiences and a hope for a future, not a set of medical codes. This worked in med school, but in practice – within an overloaded system, where clinicians are burdened with technology systems that almost force an itemization of care – it can be a difficult lesson to remember.
EHRs have represented a path forward in many ways. But within hospitals and clinics, they are mostly viewed as a contributor to the thousands of “clicks” that dominate a clinician’s day.
The stress of the ever-present pager and the piling up of administrative tasks like phone calls and portal messages becomes a distraction, consistently pulling us away from face-to-face time with patients. Without these disruptions, clinicians could have the time and space to sit with a patient and really hear their story, and to work together to forge a path toward good health. Patients need to trust their clinician, and that trust is earned in moments like this.
What is needed to create those moments is technology that can actually eliminate administrative tasks. Not simplify or streamline them, but take them completely off of clinicians’ plates. Technology that frees clinicians up to be clinicians who can put both medical expertise and empathy into their practice.
This is what AI is introducing to health care. Recent advancements in AI, machine learning, and large language models are already proving they can make a real impact on the practice of medicine by automating many of the administrative tasks that dominate their day. Suddenly, every clinician has the ability to have an autonomous resident over their shoulder – one that bears the brunt of their many distractions and empowers them to provide the type of care they were trained to provide.
The promise of AI is an attainable one. I truly believe it will allow us to return to the reason why I got into medicine – to be present and engaged with my patients, and to help them understand they have the support and counsel of clinicians who not only care, but have the capacity to care.
The young woman who was diagnosed with glioblastoma early in my career eventually passed. But near the end of her journey, she wrote me a thank-you note for the care and compassion I provided to her. I still have that card, 12 years later, as a reminder of why being present is non-negotiable in health care.
As clinicians, we exist at critical moments in the lives of the people we treat. We need time to honor that, fully. That’s what I long to return to when technology has finally fulfilled its promise to clinicians. And the nearest road to that future is being paved by AI.
Matthew Troup is a physician assistant and health care executive.